Schizophrenia: Beyond the Myths, Toward Understanding

A guest post by psychologist Dom de Lima.

Today, I present another guest post by the amazing

Dom de Lima

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When you hear the word schizophrenia, what comes to mind?

A fragmented mind? Unpredictability? Violence? If so, you’re not alone. Schizophrenia is frequently misrepresented, with misconceptions and stigma continuing to shape public perception despite decades of research.

So how did we get here? Much of this misunderstanding comes from how schizophrenia is portrayed in both news and entertainment media. These depictions often prioritise shock value over accuracy, reinforcing harmful stereotypes that fail to reflect the lived experience of those with the condition. However, the consequences go beyond misinformation; they shape policies, treatment access, and social attitudes, deepening the isolation many individuals with schizophrenia face.

Here, I separate fact from fiction, using research to debunk myths about schizophrenia. Understanding what it is (and what it isn’t) helps us see it without prejudice and more clarity.

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What is Schizophrenia?

Schizophrenia arises from a complex interplay of genetic predisposition and environmental factors that shape neurodevelopment. These factors alter how brain circuits form and function, particularly in areas involved in perception, reasoning, and emotion [1,2].

At the core of schizophrenia lies an imbalance in brain chemistry and structure. For example, dopamine, a neurotransmitter crucial for motivation and perception, becomes dysregulated in specific neural pathways. According to the dopamine hypothesis, excessive dopamine activity in the mesolimbic system is associated with symptoms such as hallucinations and delusions [3]. To counter this, antipsychotic medications work by blocking dopamine (D2) receptors, reducing overstimulation and helping stabilise perception [4].

Think of it like adjusting the volume on a speaker. When dopamine levels are too high, the brain amplifies signals that shouldn’t be as loud. Antipsychotics turn the volume down, making perceptions more manageable and reality more stable.

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How Schizophrenia Manifests

The effects of these brain disruptions show up in two ways:

Altered experiences (positive symptoms): These add to a person’s perception of reality, creating sensations or thoughts that wouldn’t otherwise be there.

• Hearing voices or seeing things that others do not: auditory hallucinations are the most common.

• Strong, unwavering beliefs that contradict reality, such as feeling watched or convinced of having special abilities.

• Fragmented or disorganised thoughts that make it difficult to follow conversations or express ideas clearly.

Diminished abilities (negative symptoms): These subtract from daily functioning, making social and personal interactions harder.

• A sense of detachment from daily life, leading to a loss of motivation or difficulty setting goals.

• A muted emotional range, where expressions, gestures, and tone of voice seem subdued.

• Social withdrawal, often stemming from difficulty relating to others.

These symptoms fluctuate over time, sometimes intensifying, sometimes fading into periods of relative stability.

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Now that we have a clearer understanding of how schizophrenia manifests, let’s take a closer look at some of the persistent myths surrounding it, and how they compare to reality.

Myth #1: Schizophrenia Means Having Multiple Personalities

One of the most enduring misconceptions about schizophrenia is that it involves multiple personalities.

But let’s be clear: Schizophrenia fundamentally alters cognition and perception but does not fragment identity, as seen in dissociative disorders. Due to changes in brain structure and function, schizophrenia alters how a person interprets reality, leading to hallucinations, delusions, and disorganised thinking. In contrast, Dissociative Identity Disorder (DID) (formerly known as multiple personality disorder) is a separate psychiatric condition involving distinct identity states [5].

That said, schizophrenia is not entirely disconnected from personality psychology. Schizotypy, a set of personality traits linked to unusual thinking, perceptual distortions, and mild paranoia, exists on a spectrum [6]. Surely, most people with schizotypal traits never develop schizophrenia, but these characteristics share some cognitive and perceptual similarities with the condition.

So why the confusion? Given their complex nature, it’s easy to see how schizophrenia and DID get mistaken for one another. But at their core, they are fundamentally different: Schizophrenia distorts reality; DID disrupts identity.

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Myth #2: People with Schizophrenia Are Violent

One of the most harmful misconceptions about schizophrenia is that it makes a person dangerous. As Leon highlighted in a recent post, the word “psychotic” is often wrongly used interchangeably with “psychopathic,” creating even more confusion. But these terms describe completely different things:

• Psychotic – A state where a person loses touch with reality (as seen in schizophrenia).

• Psychopathic – A personality trait linked to manipulative and antisocial behaviour [7].

Despite this fundamental difference, the media frequently blurs the line, portraying schizophrenia as calculated violence. In reality, the condition is marked by distress, confusion, and vulnerability.

Admittedly, in rare cases, schizophrenia-related symptoms can contribute to aggression. For example, in cases when a person experiences command hallucinations. This type of auditory hallucination instructs people with the condition to perform certain actions, sometimes involving self-harm or harm to others [8]. While command hallucinations can be distressing, research indicates that most individuals with schizophrenia do not act on them, particularly with appropriate treatment and support.

The reality? People with schizophrenia are far more likely to be victims of violence than perpetrators. In fact, they face higher rates of victimisation, often due to social isolation, homelessness, and difficulty accessing care [9]. Thus, instead of fuelling fear, the media should focus on education, because in the end, stigma does far more harm than schizophrenia itself!

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Myth #3: Schizophrenia Is Untreatable

Schizophrenia is often perceived as a diagnosis of inevitable decline. But in reality, while schizophrenia is a lifelong condition, it is also highly treatable. With the right support, many people manage their symptoms effectively and lead fulfilling lives.

Antipsychotic medications help regulate dopamine, reducing symptoms like hallucinations, while therapy and psychosocial interventions improve daily functioning and coping skills. Support networks, including family, employment opportunities, and community integration, are also key to enhancing wellbeing and reducing relapse risk.

Emerging treatments, such as transcranial magnetic stimulation (TMS) [10] —which uses magnetic fields to stimulate brain activity—show promise in alleviating symptoms, particularly for those resistant to medication.

The idea that schizophrenia is untreatable is not just wrong. It’s harmful! This belief discourages people from seeking help, fuels stigma, and reinforces the misconception that a diagnosis is a life sentence.

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So, how Is schizophrenia diagnosed?

Schizophrenia lacks a definitive biomarker. That is, there’s no brain scan or blood marker that gives a clear yes or no. Instead, diagnosis relies on clinical assessments that consider a person’s thoughts, behaviours, and overall functioning. And despite affecting about 1% of the population worldwide, schizophrenia manifests differently in each person.

This speaks to something bigger: no two human experiences are identical. Just as no two people process emotions, memories, or challenges in exactly the same way, no two cases of schizophrenia unfold in the same pattern. Mental health is deeply personal, shaped by an intricate mix of biology, experience, and environment.

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Is There a Single Cause?

I like to believe that if schizophrenia had a single cause, we would have found it by now. But rather, it arises from a complex interplay of genetic, neurobiological, and environmental factors.

• Genetics play a role, but no single gene "causes" schizophrenia. While having a relative with the condition increases risk, many people with schizophrenia have no family history of the condition.

• Brain differences (particularly in dopamine regulation and neural connectivity) affect perception, cognition, and motivation.

• Environmental factors like stress, trauma, and prenatal complications can increase vulnerability.

In sum, schizophrenia arises from a convergence of biological predisposition and environmental influences rather than a single causative factor. Scientists are still piecing the puzzle together, but one thing is clear: it’s not just genetic or biological. It’s bigger than that.

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Rethinking Schizophrenia through Science

Does this challenge the way you previously thought about schizophrenia?

Again schizophrenia is one of the most misunderstood mental health conditions, but now that we’ve stripped away some myths, does it seem less like a cause for prejudice and more like a condition deserving of understanding?

In reality, schizophrenia is not what media and misconceptions have made it out to be. It’s not split personality, not a violent disorder, and not a hopeless diagnosis. It’s a complex condition that affects perception and thought, and it affects people just like you and me. Many manage their symptoms, build relationships, and live meaningful lives.

So, what do we do with this knowledge? Do we let outdated information keep shaping how we see schizophrenia, or do we choose to approach it with more understanding, less stigma, and a willingness to see the reality beyond the myths?

Both the language we use and the perspectives we adopt shape how schizophrenia is understood in society. Therefore, changing the conversation starts with each of us.

What will you take away from this?

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Reference List:

[1] Schmitt, A., Falkai, P., & Papiol, S. (2022). Neurodevelopmental disturbances in schizophrenia: Evidence from genetic and environmental factors. Journal of Neural Transmission, 130(1), 1-12. https://doi.org/10.1007/s00702-022-02567-5

[2] Reckziegel, R., Czepielewski, L. S., Hasse-Sousa, M., Martins, D. S., de Britto, M. J., Lapa, C. D. O., ... & Gama, C. S. (2021). Heterogeneous trajectories in schizophrenia: Insights from neurodevelopment and neuroprogression models. Brazilian Journal of Psychiatry, 44(1), 74-80. https://doi.org/[Insert DOI if available]

[3] Stahl, S. M. (2018). Beyond the dopamine hypothesis of schizophrenia to three neural networks of psychosis: Dopamine, serotonin, and glutamate. CNS Spectrums, 23(3), 187-191. https://doi.org/10.1017/S1092852918001013

[4] de Greef, R., Maloney, A., Olsson-Gisleskog, P., Schoemaker, J., & Panagides, J. (2011). Dopamine D2 occupancy as a biomarker for antipsychotics: Quantifying the relationship with efficacy and extrapyramidal symptoms. AAPS Journal, 13(1), 121-130. https://doi.org/10.1208/s12248-010-9247-4

[5] Gleaves, D. H., May, M. C., & Cardeña, E. (2001). An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychology Review, 21(4), 577-608. https://doi.org/10.1016/S0272-7358(99)00073-2

[6] Mason, O. J. (2015). The assessment of schizotypy and its clinical relevance. Schizophrenia Bulletin, 41(Suppl. 2), S374-S385. https://doi.org/10.1093/schbul/sbu194

[7] De Brito, S. A., Forth, A. E., Baskin-Sommers, A. R., Brazil, I. A., Kimonis, E. R., Pardini, D., ... & Viding, E. (2021). Psychopathy. Nature Reviews Disease Primers, 7(1), 49. https://doi.org/[Insert DOI if available]

[8] Salim, Z., Haddad, C., Obeid, S., Awad, E., Hallit, S., & Haddad, G. (2021). Command voices and aggression in a Lebanese sample of patients with schizophrenia. Psychiatria Danubina, 33(1), 27-35. https://doi.org/[Insert DOI if available]

[9] de Vries, B., van Busschbach, J. T., van der Stouwe, E. C. D., Aleman, A., van Dijk, J. J. M., Lysaker, P. H., Arends, J., Nijman, S. A., & Pijnenborg, G. H. M. (2019). Prevalence rate and risk factors of victimization in adult patients with a psychotic disorder: A systematic review and meta-analysis. Schizophrenia Bulletin, 45(1), 114-126. https://doi.org/10.1093/schbul/sby020

[10] Dougall, N., Maayan, N., Soares-Weiser, K., McDermott, L. M., & McIntosh, A. (2015). Transcranial magnetic stimulation (TMS) for schizophrenia. Cochrane Database of Systematic Reviews, 2015(8), CD006081. https://doi.org/10.1002/14651858.CD006081.pub2